Despite the high prevalence and morbidity, few women suffering from perinatal depression receive mental health treatment, leaving them and their offspring vulnerable to the negative effects. Treatment of perinatal depression presents special challenges since most women will not seek outpatient psychiatry care, choose not to take anti- depressant medications commonly available in medical care settings, prefer psychotherapy, and many have physical, practical, and psychological barriers. There is an urgent need to develop and adapt existing, traditionally delivered evidence-based psychotherapies in order to improve acceptability of and adherence to effective depression treatment. Thus, the overall goal of this proposal is to develop a psychotherapeutic intervention tailored to the unique individual-level issues (such as physical mobility, energy and childcare limitations, stigma, and preference for psychosocial treatments) faced by women during the perintal period as identified in obstetrics settings. Specifically, both the treatment delivery method and content of an existing, evidence-based depression treatment (Cognitive Behavioral Therapy-CBT) will be adapted based on information learned from our target population as part of this phased project. Three phases of this intervention development proposal will 1) further elucidate and characterize barriers to participation in existing evidenced-based treatment through qualitative analyses of semi-structured interviews, 2) adapt and further develop an existing manualized, evidence based psychotherapy (CBT) based on information learned to be tested in an open pilot, and 3) test and further refine the intervention in a randomized pilot trial (n=60) so that methodological parameters may be estimated and the appropriateness of the intervention for women from different socioeconomic and racial / ethnic backgrounds may be further refined for an optimal test of the intervention in a larger, scientifically rigorous clinical trial. The planned trial designed to test the efficacy of the adapted treatment will proposed in an R01 application. This research seeks to improve the effectiveness of evidence-based psychotherapy by addressing both the treatment content and delivery modality needs of pregnant and post-partum women, and therefore improving depression outcomes for a broader number of depressed, high-need, untreated women. This research aims to improve upon the psychological treatment options for pregnant and post-partum women with untreated depression. Increasing the acceptability and effectiveness of depression treatments for depressed, childbearing women has the potential to prevent behavioral and mental health risk to their children.